Looking forward on health policy after midterm elections
November 26, 2018
Contributor
Stephanie Pavol
Essential Insights Editor; Communications Manager, Cardinal Health
Featured experts
Jim Flood
Partner, Crowell & Moring
Scott Douglas
Senior Policy Director, Crowell & Moring
Wrap-up of the 115th Congress
Pavol: What were some of the notable pieces of healthcare-related legislation to get passed during this most recent Congress? What other notable legislation impacted the healthcare industry, e.g. tax reform?
Douglas: The 115th Congress has met since January 3, 2017 and concludes on January 3, 2019. The first year was dominated by trying to repeal and replace the Affordable Care Act (ACA). In 2018, there was a focus shift to proactive healthcare unrelated to the ACA.
Flood: In 2018, Congress was dominated by the opioid crisis. As we end this Congress, the opioid bill passed and will be implemented in the next Congress. Another trend we saw is that politicians underestimated how widespread chronic disease is and how important it is to preserve coverage for those with pre-existing conditions. Healthcare is one of today’s most important issues. Drug prices are rising, out-of-pocket costs are rising, and people are more attuned than ever to the costs of care.
Douglas: Tax reform is another piece of legislation that impacted the healthcare industry, including hospitals, medical device manufacturing and patients. Generally, the tax cuts passed in late 2017 helped to spur increased individual and corporate spending and helped fuel further economic expansion in 2018. Many healthcare companies benefitted from this, but they also stand to see higher operating costs if the increased tariffs on goods manufactured in China (the so-called 301 tariffs) continue into 2019. Quickly resolving the trade dispute with China should be a top priority for President Trump and Congress, and healthcare companies should be communicating this to their elected representatives. Politically, this should be of paramount interest to Trump and Congress, as the tariffs threaten to weigh on the economy and reverse the gains that the tax cuts helped to produce.
What will get done by the end of this session
Pavol: What pieces of healthcare-related legislation might get done by the end of 2018 (specifically, looking at the American Innovation Act)? Where do you see President Trump’s latest drug pricing proposal going? Is it feasible?
Flood: In the 115th Congress, the House dealt with the American Innovation Act, but we’re not sure if there are enough votes in the Senate. Republicans in the House will want it to pass, but the Senate will not get the required 60 votes for it without support from Democrats, which appears unlikely.
Trump’s latest drug pricing proposal – the International Pricing Index model – would base Medicare Part B drug prices on other countries’ costs. Although not feasible in its current form, the Administration is dedicated to moving the concept forward. The proposed model doesn’t require Congressional approval, but pushback from lawmakers could lead to the Administration altering the proposal or scrapping it altogether.
There are other proposals from the President’s drug pricing plan that we expect to see movement on next year, some of which do require Congressional approval. There is also bipartisan agreement around improving transparency and bringing costs down.
Douglas: Cost is a big concern, and drug pricing has long been pursued by Congress. The administration responded to that with the President’s drug pricing blueprint.
What we could expect next year for healthcare policy
Pavol: What can we expect in terms of healthcare policy priorities with a divided Congress? Where do you see the “Medicare for All” proposal going? What other healthcare policy issues can we expect to hear more about next year?
Flood: Democrats won the House, so I see them attempting to move legislation toward a “Medicare for All” single payer model – more insurance, less co-pays, lower out-of-pocket costs – but it would be shut down in the Senate with the Republican majority. One can also expect that healthcare advocates and stakeholders including PhRMA, insurance companies, manufacturers and hospitals would galvanize in strong opposition. Nonetheless, Democrats could use their majority to elevate this as a campaign issue in 2020.
There’s also a strong potential that a Democrat House majority may work with President Trump on drug pricing proposals.
Douglas: With policy ideas coming out of the House, the tone will change. Democrats will work to protect the ACA. Additionally, in 2019 we’ll see more discussion around increasing the accessibility of healthcare for people in rural areas. In rural places, people drive long distances for medical care, especially if they have chronic conditions. Issues surrounding telehealth and telemedicine will be deferred until 2019.